New guidelines are here. The Prostate Cancer Foundation of Australia and the Australian Government Department of Health, Disability and Ageing have released the 2026 Guidelines for the Early Detection of Prostate Cancer. One in seven Australian men will be diagnosed with prostate cancer. The aim is to find early prostate cancer in the men most at risk, while sparing low-risk men tests they do not need.

The story starts in forensic science. In the 1960s, crime labs needed a better way to detect semen than finding sperm, which break down within minutes to an hour. Dr Travis Brown explains how the Japanese forensic scientist Mitsuhara identified a protein he called gamma-seminoprotein. Teams at Cornell and the University of California found the same protein under other names. Today we call it PSA. By the 1970s, researchers saw it was raised in advanced prostate cancer, and its long, debated path as a screening test began.

The last guidelines came out in 2016. Since then, two things have shifted the balance of risk and benefit: access to multiparametric MRI, and the move from transrectal to transperineal biopsy. In this episode, Ken walks through the key changes:

• Free-to-total PSA ratio is no longer needed. MRI is better at sorting risk. About 80% of men with a confirmed PSA above 3 already have a free-to-total ratio below 25%.
• Ages 45 to 49 (higher risk): refer when PSA is above 1 ng/mL. This group includes men with a brother with prostate cancer, a father diagnosed at 65 or younger, or a BRCA mutation.
• Ages 50 to 69: the threshold stays at 3 ng/mL, or 2 ng/mL for higher-risk men.
• Ages 70 and over: for men likely to live more than seven years, the threshold is 5.5 ng/mL. Men below 5.5 can reasonably stop testing.
• Repeat the test in one to three months. About 30% of men with a PSA above 3 will test well below 3 on repeat, often due to BPH-related variation.
• GPs should now start the conversation. The 2016 guidelines had GPs respond when a man raised it. The new guidelines, endorsed by the RACGP, ask GPs to raise PSA testing with men aged 50 to 69.

Not for prostate cancer screening. In the evidence, rectal exams by non-specialists added as many false positives as false negatives. Ken notes that urologists still gain useful information from it, and a rectal exam remains relevant when you are looking for rectal cancer.

Men with a first-degree relative with prostate cancer, men with BRCA mutations, and men of African ancestry. The guidelines also name Aboriginal and Torres Strait Islander men as a priority population because of poorer access to care. Ken adds that men in regional Victoria have worse prostate cancer outcomes than men in the city.

This is the story of the 2026 Early Detection of Prostate Cancer.

Useful Link:

2026 Guidelines for the Early Detection of Prostate Cancer in Australia

Our Special Guest:

Professor Ken Sikaris is a chemical pathologist and head of clinical integration at Dorevitch Pathology. He is a NATA laboratory assessor, a founding fellow of the RCPA Faculty of Science and a principal examiner in pathology informatics. Ken was one of the first people to measure PSA in Australia, bringing in some of the first test kits around 1989. He helped write the new guidelines.

Listen:

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In 1880, a French physician described a patient having up to 200 sleep attacks a day, some triggered by nothing more than a good hand of cards or the sight of his own wine barrels. That case, and an earlier 1877 description from German psychiatrist Carl Westphal, gave the condition its name and its first clinical picture. Dr Travis Brown reads from both original case reports before turning to two guests for where narcolepsy stands today.

Di Spillaine, an Australian narcolepsy advocate and lived experience educator, describes going almost 40 years undiagnosed, mistaking her symptoms (childhood hallucinations, cataplexy triggered by laughter, sleep paralysis) for ordinary tiredness until a multiple sleep latency test finally confirmed narcolepsy. Professor Robert Adams, a respiratory and sleep physician at Flinders Medical Centre and medical director of the Adelaide Institute for Sleep Health, explains the underlying orexin deficiency behind narcolepsy type 1, how it differs from everyday tiredness and other sleep disorders, and the diagnostic pathway, including the Epworth Sleepiness Scale and multiple sleep latency testing.

What to listen for: the questions Professor Adams suggests a GP ask beyond “are you tired”, and why narcolepsy sits, in his words, at the end of the queue of likely causes but should still be considered in young patients with long-standing, profound sleepiness.

This is the story of narcolepsy.

Useful Link:

Epworth sleepiness scale: https://www.cdc.gov/niosh/work-hour-training-for-nurses/02/epworth.pdf

Our Special Guests:

Di Spillaine is an Australian narcolepsy advocate, lived experience educator and creator of the podcast Waking Up Tired: Narcolepsy Symptoms Explained

Professor Robert Adams is a respiratory and sleep physician at Flinders Medical Centre and medical director of the Adelaide Institute for Sleep Health at Flinders University

Listen:

This Medical Life podcast is available on all podcasting services, Apple Podcasts, YouTube, and Spotify. Members of the RACGP are able to log the hours as CPD (Education) that they listen to the episodes under self record via Quick log. We invite you to help support us on our donation page.

See omnystudio.com/listener for privacy information.

Sexual harassment in medicine is almost universally perpetrated by men, and in over half of doctor-on-doctor cases, it happens in the workplace itself, not at a conference or a staff event. That is one of the findings from a decade of research by Dr Louise Stone, who began this work in 2014 after a young intern disclosed a sexual assault to her in consultation.

Dr Travis Brown speaks with Dr Louise Stone, a professor of general practice with expertise in doctors’ health, sexual safety and professionalism, about what her research uncovered.

Dr Stone identifies two distinct groups of perpetrators: persistent predators who choose careers with access to power, and a smaller group of senior doctors, often isolated by decades of on-call work, who form inappropriate attachments without the same pattern of repeat behaviour. She explains why junior doctors on rotating three-month terms are especially vulnerable, why specialties such as surgery, psychiatry and pathology carry disproportionate risk, and why zero tolerance policies tend to drive the problem underground rather than reduce it. She also sets out what she has found does help: peer intervention from someone at the same level of seniority as the person behaving badly, and giving survivors clarity on what they actually want from a reporting process, whether that is justice, protection of others, or simply healing.

What to listen for: The early warning signs Dr Stone flags for junior doctors and medical students, and why a colleague’s discomfort is worth naming rather than dismissing.

This is the story about sexual harassment in medicine.

Our Special Guest:

Dr Louise Stone is a professor of general practice, previous lead medical educator for GP training in Australia, and author of Sexual Harassment Between Doctors: Healing Medical Cultures Around the World, available from her website: https://www.drlouisestone.com

Listen:

This Medical Life podcast is available on all podcasting services, Apple Podcasts, YouTube, and Spotify. Members of the RACGP are able to log the hours as CPD (Education) that they listen to the episodes under self record via Quick log. We invite you to help support us on our donation page.

See omnystudio.com/listener for privacy information.